Journal Watch - 2017

PD for People with PKD—It’s Possible

Many believe that large, polycystic kidneys make PD impossible. A review has concluded that PD is well-tolerated in those with autosomal dominant PKD, with outcomes that are equivalent—or better—than in other patient groups.

The Impact of ESRD Treatment Modality on Sleep Quality

A metaanalysis looked at whether changing from one treatment type to another (HD, daily HD, nocturnal HD, CAPD, CCPD, or transplant) would affect sleep. Sixteen studies with 670 patients and 191 controls were examined. Restless leg syndrome resolved in 60+% of patients who switched to CCPD, intensive HD, or transplant. Sleep apnea improved with these options as well. Overall sleep quality improved as the intensity of treatment increased.

Both UF Rate AND UF Amount Matter

Using data from 152,196 US dialysis patients, researchers looked at what would happen if UF rates were capped at 13mL/h/kg without reducing weight gain or offering longer treatments. On average, 18-36% of patients left treatment > 1 Kg above their prescribed target weights. Without adding time or reducing the gains between treatments, patients may have fluid-related weight gain.

Waist Circumference Linked to Survival on PD

A prospective study of 109 people on PD measured waist circumference (WC) at baseline and at 6 months, then followed them for 4 years. At baseline, 55% of women had a high WC (>88cm) and 23% of men did (>102cm). After 6 months, The WC of 61% of participants had increased. High baseline WC and an increase were both associated with a higher risk of death.

Patient Education Boosted Use of Home Therapies

In a 22-month period 108 people were enrolled in a comprehensive predialysis education program—and 70% chose a home treatment (55% PD; 15% home HD). Three sessions of education appeared optimal for helping patients reach a decision.

In-center nocturnal HD boosts lean body mass

Among 56 adults followed for a year, those who were randomly assigned to nocturnal in-center HD vs. standard treatments had higher, more stable interdialytic weights. The pattern of toxin removal suggests that the result is due to increases in lean body mass.

HD frequency and protein-bound solutes

Does more frequent HD do a better job of removing protein-bound solutes from the gut that are more toxic than urea? No, finds a new analysis of results from the Frequent Hemodialysis Network (FHN) trials.

Short daily HD in pediatrics

Dividing 12 hours of in-center HD into 5 weekly treatments instead of 3 was feasible and beneficial to blood pressure control in adolescents in a new crossover study. However, not surprisingly, reimbursement and time demands were challenging. (Editorial note: home treatments would allow more flexibility for school.)